From Long Island, New York, USA:
I am not sure what to do next with my two and a half-year-old daughter. About a week ago, she spent the day urinating in her pants, every 15 to 20 minutes. She is toilet trained so I just thought she was regressing. Then, two days later, it started again and even the babysitter observed it, frequent urination in potty and/or in her pants. My friend, who's young daughter has type 1, came over and tested her. My daughter's blood sugar was 315 mg/dl [17.5 mmol/L], although she had eaten a bowl of ice cream 20 minutes earlier. Forty-five minutes after the ice cream she was 285 mg/dl [15.8 mmol/L]. By the time we got to the doctor's office, her blood sugar was down to 145 mg/dl [8.0 mmol/L]. He sent us to Emergency Room where her blood sugar was normal. By then, she had not eaten for six or seven hours. I fed her turkey, cheese and pudding. She ate and the doctor said to go home. I asked for one more check before we left and she was 155 mg/dl [8.5 mmol/L], about 25 or 30 minutes after eating. The doctor was cautious but sent us home.
The next day, upon waking, my daughter's blood sugar was 185 mg/dl [10.3 mmol/L]. One hour after eating cereal, it was 211 mg/dl [11.7 mmol/L]. Later in the day, after an apple and some hot chocolate, she was 173 mg/dl [9.6 mmol/L]. That night she was VERY hungry and ate spaghetti. Afterwards, she was 109 mg/dl [6.1 mmol/L]. She went to bed, but woke up vomiting at midnight. She was 132 mg/dl [7.3 mmol/L] at that time. She vomited all night and her numbers went up to 142 mg/dl [7.9 mmol/L] and 207 mg/dl [11.5 mmol/L]. By 8:00 a.m., she was 122 mg/dl [6.8 mmol/L] with no food in her belly since 6:30 p.m. the night before. At 2:00 p.m., she was 84 mg/dl [4.7 mmol/L], still no food. Two hours later, she had chicken nuggets and juice. At 6:00 p.m., her blood sugar was 91 mg/dl [5.1 mmol/L]. The next day, her diet was limited but her blood sugars ran normal.
By then, we were ready for our scheduled endocrinology appointment. When she got there, she was 93 mg/dl [5.2 mmol/L] on a 12 hour fast. The endocrinologist attempted a fasting glucose test but was unable to perform it; they couldn't get the line in after four tries so they gave up and sent us home. On the way home, I gave her chicken nuggets and fries. One hour later, she was 204 mg/dl [11.3 mmol/L] so I called the doctor who basically told me to stop worrying, that neither he nor the endocrinologist thought my daughter has diabetes because she has no sugar in her urine.
My daughter's blood sugars continue to fluctuate, but are mostly in the normal range. Forty minutes after a bowl of ice cream, she was 237 mg/dl [13.2 mmol/L]. Yesterday, two hours after eating lunch, she was 142 mg/dl [7.9 mmol/L]. One hour after a dinner of macaroni and cheese, I got four readings - 133 mg/dl [7.4 mmol/L], 111 mg/dl [6.2 mmol/L], 103 mg/dl [5.7 mmol/L], and 125 mg/dl [7.0 mmol/L]. I am at my wits' end wondering if I should keep testing this poor little girl because I am fearful that this is the early onset of diabetes. However, the doctors are telling me they don't think she has it at all. I forgot to mention that, in the hospital, her A1c was 5.9, again, nothing decisive. She seems to be teetering back and forth. Is this normal? How high can she get post food before it is considered higher than normal? Today, I thought she would be high after one half of a bagel, half a banana and apple juice, but she was only 107 mg/dl [5.9 mmol/L]. What do you suggest I do? I know I've thrown out a lot of numbers at once, but I'm just trying to explain the ups and downs. The ADA help line told me I should check her one hour after meals, not two because that's what I've found to be her spike time, before the numbers start to come down. On the other hand, then sometimes I check one hour later her blood sugar is normal! I am SO confused.
It sounds like the beginnings of diabetes from your description. I wonder if anyone checked antibody levels: islet cell, GAD-65 and IA 2. The results, if positive, would tell you this definitely is diabetes in its early stage. Sometimes these antibody tests are negative, however (about 20 to 40% of the time). Sometimes there are intermittent failures of the beta cells and then some recovery but the values you report, associated with symptoms, are very abnormal and too often to be an oddity.
I certainly would continue to check blood glucose levels and treat her with a meal plan that restricts fast acting carbohydrates. Time will help to decide what next needs to be done since it will depend upon how often the blood sugar levels are normal and how often abnormal. You are correct that pre-food blood glucose normally should be 70 mg/dl [3.9 mmol/L] to 99 mg/dl [5.5 mmol/L] and post-food never should be more than 140 mg/dl [7.8 mmol/L] (some would say 126 mg/dl [7.0 mmol/L]). Clearly, the values you have are intermittently extremely higher than the normal range and she has symptoms that go along with hyperglycemia as well. I would either go back to your diabetes team for follow-up or get another opinion with another pediatric diabetes team since you need ongoing surveillance and assistance with meal planning, monitoring, follow-up laboratory work, etc.
Original posting 25 Jan 2009
Posted to Diagnosis and Symptoms
Last Updated: Tuesday April 06, 2010 15:10:16
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